Psychological support for orthognathic patients: Who is doing what?

OBJECTIVE: To investigate: (1) orthodontists' training experience in the psychological assessment of orthognathic patients and their wish for training/further training; (2) the availability of psychological support, referral patterns and outcomes after referral; (3) and adverse incidents prompting orthodontists to refer patients for psychological assessment. DESIGN: Prospective cross-sectional study. METHODS: A 25-item questionnaire was designed to investigate the above mentioned aims. After a pilot study, the questionnaire was distributed to all members of the Consultant Orthodontist Group, British Orthodontic Society. RESULTS: Based on a 29.1% response rate (n = 102), 76.5% of respondents had undertaken training in identifying orthognathic patients who may benefit from psychological assessment. However, 90.2% favoured further training. All respondents believed that some orthognathic patients would benefit from referral; however, 31.3% of units referred no patients at all, mostly due to limited/no access (66.7%). Most referrals (68.9%) were to psychiatrists/psychologists with dentofacial deformity expertise, with 28.9% of units having such services onsite (14 different units). Psychological referrals had potentially useful outcomes, with 36.4% of respondents sometimes changing treatment plans following referral. Clinical incidents were experienced by 35.1% of respondents, prompting referral of patients for psychological assessment; such incidents included patient suicides (n = 4). CONCLUSION: Most respondents had trained in psychological assessment of orthognathic patients; however there was a large demand for further training. Clinicians value the psychological services available; however, limited availability may affect referrals for some respondents. Adverse incidents are of real concern and highlight the need to ensure that training and resources are provided to support orthognathic patients and teams.

The impact of altered sensation affecting the lower lip after orthognathic treatment.

PURPOSE: Inferior dental nerve paresthesia is a well-known risk of orthognathic surgery, but little is known about the effects of altered sensation in day-to-day life. Therefore the aim of this study was to assess the impact of altered sensation after orthognathic treatment. PATIENTS AND METHODS: The study was divided into 2 parts: the first phase involved semistructured, in-depth interviews with 13 post-treatment orthognathic patients who presented with altered sensation affecting the lower lip. In the second part of the study, the data from the interviews were used to develop a questionnaire that was distributed to 40 post-orthognathic patients (75% completion [n = 30]). The results were analyzed by use of descriptive statistical methods. RESULTS: In both stages of the study, common descriptors used to describe the altered sensation were "tingling" and "numb." The majority of patients were aware of the neurosensory disturbance when touching their lips, face, or jaw, and patients also expressed difficulties knowing when food was left on their lip. It was noted that patients who were aware of the altered sensation all of the time expressed the greatest distress in their everyday life. When it came to emotions associated with the altered sensation, the majority of patients were disappointed, but few were upset or angry. CONCLUSIONS: The impact of altered sensation due to inferior dental nerve damage after orthognathic surgery varied from patient to patient, but altered sensation had a significant effect on the majority of patients' everyday lives. The information obtained from this study makes an important contribution to the informed consent process.

A new style of orthognathic clinic.

The Orthognathic Team at the Eastman Dental Hospital has developed a new style of multidisciplinary clinic to supplement the traditional orthognathic consultation. The aim of the new clinic is to increase patient satisfaction and involvement in the consent and decision making process, as well as optimizing the information given to prospective patients regarding all aspects of this complex elective treatment. Results of a survey of patients attending the clinic found that 80% thought that the information given was 'just the right amount' and 96% were satisfied with the new structure. They particularly found it useful to meet a patient who had completed treatment. All of those who attended said that they understood the information given to them and would recommend the clinic to those considering orthognathic treatment. They also liked having other patients there with them on the clinic.

Orthognathic treatment: see how they feel?

As clinicians we are becoming increasingly careful in our pre-treatment screening processes and in acknowledging the importance of psychological assessment of potential orthognathic patients. However, this does not necessarily guarantee post-treatment satisfaction, even if the clinician thinks the clinical outcome is good. This paper provides the clinician with a schematic framework of those factors which may affect post-treatment outcomes.

A qualitative study of orthognathic patients' perceptions of referral to a mental health professional: part 1--questionnaire development.

OBJECTIVES: The aim of this study was to develop a measure to assess orthognathic patients' perceptions of referral to a mental health professional. DESIGN: Prospective qualitative study. SETTING: UCLH Foundation Trust. SUBJECTS AND METHODS: The study was divided into two parts. The first phase involved developing a patient-centred questionnaire by carrying out semi-structured interviews with 10 orthognathic patients and 10 clinicians involved in orthognathic treatment provision. The transcripts from these interviews were then analysed using the N6 software package for qualitative research and thematic content analysis was carried out. As key themes and theories of patients' perceptions of referral to a mental health professional began to emerge from the data, this directed the source of further interviews, allowing exploration and validation of all theories. When new themes ceased to arise, it was assumed that data saturation was reached, and no further interviews were undertaken. A questionnaire was then developed using the key themes from the interviews and this was piloted. RESULTS: Analysis of the interviews revealed that patient views could be divided into two main themes: service provision and perceptions of mental health professionals. These themes were incorporated into a questionnaire. CONCLUSIONS: A new measure of patients' perceptions of referral to a mental health professional is presented.

A qualitative study of orthognathic patients' perceptions of referral to a mental health professional: Part 2--a questionnaire study.

OBJECTIVES: There is evidence to suggest that clinicians are reluctant to refer orthognathic patients for psychological evaluation due to fear of the patient reacting badly to the suggestion. The aim of this study was to assess orthognathic patients' perceptions of referral to a psychiatrist/psychologist using a previously developed patient-centred questionnaire. METHODS: The study was divided into two parts. Stage 1 (presented previously) involved developing the questionnaire using qualitative methodology and stage 2 involved distribution of the questionnaire to 63 orthognathic patients. This paper describes the findings of stage 2. SETTING: UCLH Foundation Trust. RESULTS: The majority of patients viewed referral to a psychiatrist/psychologist positively (95.2%), the main benefits being having someone neutral to talk to who could explain and prepare them for treatment. Patients said they would prefer the referral to be made by the clinician they are most familiar with and to see the psychiatrist/psychologist on a one-to-one basis (79.4%) in an environment they are familiar with. The main perceived drawback of seeing a psychiatrist was the inconvenience of an additional visit. CONCLUSIONS: Fear of the patient reacting badly to being referred to a mental health professional appears to be unfounded in this study of patients from a large teaching hospital and should not prevent clinicians referring patients whom they think would benefit from this.

Motivation for orthognathic treatment and anticipated satisfaction levels-a two-centre cross-national audit.

PURPOSE: This audit investigated factors which motivate patients to seek orthognathic treatment, assessed how confident patients were that they would be satisfied with the outcome of treatment, and explored possible influencing factors. MATERIALS AND METHODS: Questionnaires were distributed to pre-surgical patients at two centres (United Kingdom and Switzerland); questions asked what patients wished to gain from orthognathic treatment and how confident they were that they would be satisfied with treatment outcome. Gender, age and location were recorded as demographic variables, and type of malocclusion was also recorded. RESULTS: A total of 202 questionnaires were returned (UK, n = 149; Switzerland, n = 53). Reported motivating factors focused on improvements in aesthetics (specified and unspecified) (UK vs. Switzerland: 91.3% vs. 83.0%), function (72.5% vs. 66.0%), psychosocial health (51.7% vs. 20.8%), speech (4.0% vs. 7.5%), alleviation of pain (5.4% vs. 17%) and normalization of breathing (1.3% vs. 7.5%). No significant relationships were observed relative to patient age, gender or malocclusion. The anticipated satisfaction levels were generally high (86.5% vs. 89.9%). CONCLUSION: Although the distribution of motivational factors varied between the two sites, it did not affect the anticipated satisfaction level. Patients were generally confident that they would be satisfied with their treatment outcome and that their reasons for seeking treatment would be addressed.